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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.9 Private Duty Nursing (CCP) : 2.9.3 Prior Authorization and Documentation Requirements : Recertifications of Authorizations
Completed extension requests must be received and dated by CCP at least seven calendar days before, but no more than 30 days before, the current authorization expiration date. The request must be received by CCP no later than 5 p.m., Central Time, on the seventh day, to be considered received within seven calendar days. If a request is received less than seven calendar days before the current authorization expiration date, or after 5 p.m., Central Time, on the seventh day, authorization is given for dates of service beginning no sooner than seven calendar days after the receipt of the completed request by CCP.
Recertifications may be prior authorized for up to six months. The following criteria are required for recertification authorization:
The recertification process includes the following:
All required documentation for PDN services (including the Physician POC, the Nursing Addendum to POC, and the CCP Prior Authorization Request Form)
CCP Private Duty Nursing six-Month Authorization form, which must be signed and dated by the primary physician, nurse provider, and client, or responsible adult
The nursing care provider is responsible for ensuring that a new Physician POC is obtained within 30 calendar days of the authorization period ending and maintained in the client’s record. Providers should not submit interim POCs to CCP unless requesting a revision.
The nursing care provider must notify CCP at any time during the authorization period if the client’s condition and need for skilled nursing care significantly changes.
The nursing care provider may request a revision from TMHP at any time during the authorization period if the client’s condition requires it.
All authorization timelines apply to recertifications also.
Refer to:
Form CH.3, “CCP Prior Authorization Private Duty Nursing 6-Month Authorization” in this handbook.
Form CH.7, “Home Health Plan of Care (POC)” in this handbook.

Texas Medicaid & Healthcare Partnership
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